Follow-up with a Pharmacist Reduces Hospital Readmissions

Pamela Moye

A pharmacist-led follow-up after discharge significantly reduced hospital readmissions among heart failure patients aged 60 years and older, a Mercer University College of Pharmacy study has found.

College of Pharmacy researchers looked at older heart failure patients who had been admitted to WellStar Atlanta Medical Center and received either a standard postdischarge provided by a nurse or case manager or two follow-ups led by a pharmacist. They found 25 percent of patients who received a standard postdischarge follow-up were readmitted within 30 days versus 12 percent of the pharmacist-led intervention group. Approximately 96 percent of the patients in the study were African American, and African American men saw the biggest benefit—a 16 percent decrease in readmissions.

The results were published in the American Journal of Health-System Pharmacy in February.

Patients in the intervention group received medication reconciliation and counseling from a team of pharmacists, pharmacy residents and pharmacy students.

“After-care can be challenging for patients with heart failure,” said Pamela M. Moye, Pharm.D., clinical associate professor, who led the study. “They may take four or five medications, and they have strict dietary limitations, such as restricted liquid and salt intake. They need to weigh themselves each day and see their doctor regularly.”

The pharmacy team called patients 14 and 30 days after discharge to talk to them about their medications, to ask them if they have weighed themselves regularly and if they have gone to doctors’ appointments.

“A stepped-up intervention fits well with this patient population,” Dr. Moye said. “They are typically inner city residents who have a number of socioeconomic factors working against them.”

The pharmacy team, for example, made sure that patients could afford the medications prescribed to them and adjusted them if needed. “We’ve had patients say to us, ‘I hear you, but I only have $20 a month to spend on medications,’” Dr. Moye said. “We also helped another patient figure out the bus route to the nearest grocery store to pick up his medications.

“Studies have shown that pharmacists do medication reconciliation better than any other healthcare professional. We can provide one-on-one counseling to talk about a patient’s medications and disease state. And this makes sense because pharmacists are the drug experts. Pharmacists’ multidisciplinary approach improves patient health.”

Healthcare systems are beginning to look at having pharmacists provide better “transitions of care” in response to Medicare and Medicaid discontinuing reimbursement for patients with heart failure or chronic obstructive pulmonary disease if they are readmitted within 30days of discharge.

Dr. Moye’s research team included Pui Shan Chu, PHARM ’17, now a PGY-1 resident at Beaumont Hospital-Royal Oak in Michigan, Teresa Pounds, BSPHARM ’82, PHARM ‘83, clinical pharmacy manager at WellStar Atlanta Medical Center, and Maria Miller Thurston, Pharm.D., clinical assistant professor of pharmacy practice.